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General NPI Number Information
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NPI Number | 1013388479
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Entity Type | Organization
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Legal Business Name | ADVANCED INTEGRATED MEDICINE PLLC
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Dates
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Enumeration Date | 10/12/2015
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Last Update Date | 01/29/2016
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Provider Practice Location Address
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Address Line | 11465A TOEPPERWEIN RD
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City | LIVE OAK
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State | TX
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Zip | 78233-3138
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Country | US
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Telephone | 210-599-9570
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Fax | 210-599-9572
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Provider Business Mailing Address
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Address Line | 11465A TOEPPERWEIN RD
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City | LIVE OAK
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State | TX
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Zip | 78233-3138
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Country | US
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Telephone | 210-599-9570
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Fax | 210-599-9572
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Authorized Official
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Title or Position | OWNER / PROVIDER
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Name | ALY KHYM BUENTIPO ZARZUELA
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Credential | D.O.
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Telephone | 210-599-9570
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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